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Derwan. A name that would be etched in my mind for a while now. It conjured up an image of a vast desert with camels trudging everlasting dunes and distant snow covered peaks. I could just see myself in a Bedouin’s tent trying my best to conjure up an operating theatre. Well, anyway that was the image that sprang to my mind when Sanjay Deshpande asked me if I would help him out in a charity camp. Three months later, I landed in a dusty, noisy Mumbai and got into an even noisier taxi to the aptly named Kohinoor Hotel where the rest of the volunteers would meet up. I was in fact one of the first ones to turn up. It was not long before we were all suitably satisfied with a spicy breakfast and loaded onto the coach which would take us to the Walawalkar Hospital in Derwan. The coach wound its way through the mountain passes of the Western Ghats many were thankful for the antiemetic they had taken at the start. The scenery was breathtaking and the cameras clicked away as the driver took one hairpin bend after another down a steep mountain pass.

It was quite dark when we reached the hospital to my first surprise. It looked like the entire hospital had turned up including the director and the reverential Kaka Maharaj. The director, Mr Walawalkar turned out to be an extremely simple and a humble man who tried to keep himself in the background. Kaka Maharaj was another matter altogether. He was held in high esteem by everyone there, including some of some of the volunteers who had been there before. It was soon to become apparent why. He appeared to have an amazing influence on the people he met and he had a vision which appears to have worked wonders in the place. Almost single handedly, he had developed a snake and scorpion infested Konkan jungle on a mountainside into a modern hospital campus with a budding medical school. The idea was to help the downtrodden and almost completely ignored population of the region with the highest quality of healthcare for free. He had achieved a near impossible task and had visions of taking things even higher. We were simply one of the tools he was using to achieve this. The men and women who worked there gave their all to please him. The welcome we got was an example of things to come during the next week. Men fell over themselves to help us, carried our bags to the rooms allocated by our self appointed team leader, David Wales, who looked more like a sergeant major than a retired Nurse.

I met a quiet Dr Pavan Kohli for the first time and went on a grand round of the hospital to see all the patients admitted for surgery during the next five days of the camp. The ever ebullient Dr Sunil Nadkarni, who I had met before in Newcastle, accompanied us for part of the ward round and he seemed as excited as a kid at a Christmas party. As we moved from one patient to the next, I soon started to realize the extent of the problem I would face. It filled me with excitement and a sense of challenge. I was going to bring to the villagers of the Konkan region, a procedure which would help them get back to their normal life. Some of them had not walked for months and one was stuck in a wheelchair provided by the hospital for free. They were so poor that they could not afford to see a doctor let alone have a hip or a knee replacement. I knew I was going to be busy for the next six days.

Next day, off we went to the Medical school auditorium, which put our lecture theatres back in Newcastle to shame, for a grand and yet simple, welcoming reception followed by a CME program for the doctors in the surrounding region. I could not stay for long as we were starting with my first uni-compartmental knee replacement that morning. I missed most of the social side of camp as I was stuck in the operating theatre from morning till late at night. There was baby showers for dispossessed women of the region, visit to the local school and the women’s center.

My team in theatres!!

I ended up performing twenty three knee and hip replacements during the week. It soon became a routine to start the day with an excellent vegetarian Indian breakfast and operating through the day followed by a ward round ending around 9 or 10 at night. Lunch was often a quick bite in the surgeon’s room, sitting on a couch meant for rest. This routine was broken when Sanjay suggested that I should give a talk on Harappan civilisation to the volunteer group and the students and staff of the hospital and medical school. The talk on the Story of Indus Valley Civilisation was well received by one and all.

It was all over so quickly, I thought. The week had gone by very fast indeed. The highlight was on the last day of the camp when we were felicitated by Kaka Maharaj. All the girls had been given Sarees and the local nurses helped them dress up and they all looked fabulous in their colourful sarees. The local tailor had a bumper business stitching up their blouses. All the men wore new shirts given by Kaka Maharaj the day before.

After the evening meal we found ourselves sitting in a quaint little railway station, Sarwade waiting for the night train to Mumbai. The sleeper was very comfortable and the conductor was very helpful and got all of us to sleep in the same compartment. My dear friend, Seema’s driver picked me up at Dadar station, teeming with traders with trucks loaded with vegetables for the early morning market.

Flight to Bangalore was uneventful and the next week would be full of meetings, newspaper interviews and lectures. That is another story for another time!!

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The speech by Jeremy Hunt, our erstwhile Health Secretary has caused undue stress and anger among the health professionals, particularly consultants. He claims the consultant do not work over the weekends! I am not sue where he got this information from. I was operating last Saturday and counted not less than 11 other consultants working in the theatres along with number of junior doctors, nurses and allied professionals. This did not include those working in A&E, path lab, radiology etc.
He has taken a poorly performed study which only looks at gross statistics without taking into account the numerous variables which affect mortality for any admission. McCartney M in his paper (BMJ 2015;31:h3575, 6th July) unfortunately does not take into account the type of illnesses. Patients with milder illnesses are less likely to call the doctor or attend the emergency services at weekends, so there are fewer admissions and the average severity of illness is probably greater.

Prof Barer, Consultant in Stroke Medicine at Sunderland Royal Hospital has written a letter in the latest BMJ (1st August 2015) where he points out “Acute Cerebrovascular disease is the biggest single contributor to the excess of weekend deaths.” The Gateshead Stroke register shows a crude death rates of 15.5% for weekday admissions and 17.5% at weekends. There were 36% more admissions with “suspected stroke” during an average weekday than a weekend. Often the weekday admissions included higher proportion of TIA (Transient Ischaemic Attacks) and Stroke Mimics with a much lower mortality rate. The register also shows that the strokes were “milder” during weekdays.

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Instead of looking for causes of increased death rates during the weekends using standardised models, the secretary of health has used on flawed study to back his claims. If we start to change our treatment modalities based on such an example, the outcomes for our patients would be disastrous.

Mr Hunt has been bombastic about his claims and statements during his speech of 16th July. He claims that he wants to change the NHS to a more “human service.” Such statements have been made by politicians in the past and the service has veered gradually towards a Manager driven service than a clinical driven service. This has caused a top heavy service lead by managers with little or no knowledge of the clinical nature of the NHS. More often than not the service is treated in the same format as a car spare part factory. It has become a numbers driven service with managers deciding on the priority of treatment. I have had patients crippled with severe arthritis cancelled by managers to allow Bunion surgery to take place purely because they “came first”!!!!

He claims that he understands Doctors and in the same speech commands “We are ready to impose a new contract if negotiations are not successful within six weeks.” He must have taken the words straight out of Stalin’s workbook!

The online petition (https://petition.parliament.uk/petitions/104334) now has has more than 200,000 signatures. As Mahathma Gandhi once said to Lord Curzon, “It is time you left,” it is time Mr Hunt left and allowed someone else with a better understanding of the health service to take over the mantle of Health Secretary.

Prof Barer ends his letter by saying “It is time to show that policy can be based on reliable evidence rather than political expediency.”
Ref:
1. Basing seven day working on evidence not expediency, Prof D Barer, BMJ2015;351:h4061
2. Skirmish over seven day working, Mark Newbold. BMJ2015;351:h4082
3. Petition calling for health secretary’s resignation exceeds 200 000 supporters
4.McCartney. The Zombie Statistic behind the push for seven day working. BMJ2015;351:h3575

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The whole thing was like out of a dream! From the moment we landed at the sprawling Delhi International Airport the events rolled quickly and merged into one long episode. The publisher, Mr Bhaskar Roy came to meet us at the Royal Plaza hotel on Janpath, right in the middle of the city jostling with swank colonial buildings of yesteryears. He took us through the following evening’s timetable and tried to reassure my frayed nerves.

Dr Kapila Vatsyayan

There were two eminent archaeologists from the Archaeological Survey of India (ASI) who took an active part in the discussions. Dr B R Mani, current Additional Director General of ASI shed further light on the subject of Soma. The discussion went on into the evening and the book was well received. Most of the books on display were snapped up very quickly and I was kept busy signing the books long after the programme was finished. It was considered a very successful launch partly because of the presence of the Kapila Vatsyayan who does not normally attend book launches unless the book is of significance and partly because of the excellent audience participation.

We travelled to Varanasi the next morning looking forward to the charity medical camp. We were rather anxious about the whole thing as the information about the facilities was rather sketchy. We were in for a pleasant surprise. It turned out to be a new hospital, reasonably well equipped.

On the first day, we spent some time getting used to the place and the people. They gave each of us a room to examine patients and the staff went out of their way to accommodate us. Part of the problem was the language! I did not realise that a large percentage of the local population, particularly the rural areas, spoke Bhojpuri. It is closely linked to Hindi, but still not very easy to follow. It became obvious very quickly that we won’t be able to manage without an interpreter. It took over 30 minutes to see my first patient! Even Sushma appeared to enjoy herself despite being extremely apprehensive to start with. She saw several patients with surgical problems and we saw over 100 patients over two days. It was tiring but enjoyable at the same time. The director of the unit, Dr Indu Singh was a revelation to us all. She was an extremely pleasant and hard working Gyneacolgist with a very keen interest in Telemedicine to bring modern medicine to the rural masses. She has asked us to return next year to conduct CME programs, interactive workshops with the local orthopedic fraternity and expand the remit of the charity camp itself. We returned to Delhi tired, yet satisfied with our efforts.

Delhi Public School; I was not sure what to expect in the school. Mrs Aditi Misra, the principle of the school and a very dear friend had passed my talk earlier on. But I was still wary of facing a bunch of students. The school building was very impressive. It must be to host 6000 students from nursery to school leavers.

The programme was started off with an impressive dance performance by the students to a Bengali song sung by Amitabh Bhachan. The dance was extremely professional and inspiring. I did not understand the song, but the dancers were so good that it was easy to understand the theme of the dance and the story behind it. One of the girls from the Editorial Board of the school then introduced me to a packed hall and invited me to start an interactive session. I was not sure what to expect and started off tentatively to try and see how much the students knew of Harappan history. I need not have worried. The kids definitely knew more about it than I did at their stage in career. As I went on, the questions came thick and fast. Their desire to know was unstoppable. Finally, the Principal of the school, Mrs Aditi Misra signalled me to wrap it up and go on to my talk. The talk again stimulated a lot of discussion. I was then invited to be interviewed by the Editorial Board of the school. This was made up mainly of students from across the school, of all ages with one teacher guiding them in the background. This was a daunting task as their desire for information was enormous. The session was stopped by the Principal again as the school time had run out. I was on the floor for over two and half hours!!!

There was two segments to the Bangalore launch. First one was a talk to the Rotary Club organised by Srinivas Rajanna at the prestigious Century Club. The venue was overflowing with standing room only for the talk. There were a lot of questions and discussions went on into the night. There was an interesting question to finish the evening – “Are you a Doctor or a Historian now?”. I was not sure what I am now! I am a doctor by profession and history is my passion. I answered it with “I am neither. I am, but a humble orthopaedic surgeon, a frustrated carpenter!”

The last stage was a formal book release under the auspices of the prestigious MES College in Malleswaram. Known for its extremely conservative values, I was rather apprehensive about the evening. The audience was made up of journalists, authors and historians along with well wishers.

There was a panel discussion with historians and experts in the scriptures along with a professor of ancient history and an author. The evening ended well and my talk was extremely well received. All the books on display at both the venues disappeared very quickly and I ended up spending last hour signing the books.

Has it been a successful launch? Only time will tell. It was a success as far as I am concerned as it generated a lot of interest in the people who attended the programmes!!

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Good News!! Just had two reviews on A Kangaroo Court. One from a professional reviewer on GoodReads and a personal letter from a reader.:Masquerade Crew’s review Mar 23, 13

4 of 5 stars bookshelves: non-fiction

ROY’S REVIEW

This is an inside story of one man’s unfortunate experience at the hands of the (British) General Medical Council. it was the misfortune of Mr Shankar Kashyap, eminent consultant surgeon, to become the victim of the GMC’s own disciplinary processes.

With extensive use of the transcripts of the various hearings Mr Kashyap takes us from the point where life is good for him and his family. He has become an acknowledged expert in his particular specialism of hip replacements. He works hard and productively, bringing new efficiencies to his hospital and is in demand worldwide for lectures and demonstrations. His family are happy and settled.

The initial notice of complaint against him was a shock, but nothing happened for two years. Thereafter things rapidly deteriorate as he and his team of advisors battle to deal with the allegations against him. In a ridiculously long drawn out and expensive process it appears that the various assessors and panellists assigned to his case have prejudged his guilt. The charges are patently trumped up and minor but those in charge of Mr Kashyap’s destiny seem determined to ignore the mounting evidence in his favour. Meanwhile his career and life generally nosedive and he becomes understandably depressed. It takes, astonishingly, six years to determine the case and I won’t spoil the ending.

This is a fascinating read, even for someone who dropped Biology like a stone at the earliest opportunity at school. For medical practitioners and students it will shock and astonish. Although it is maybe overlong the author has a flowing and engaging style that draws one along relentlessly.

One big minus point though. I’m afraid there is little evidence of proof-reading after the half-way point. The text is dripping with poor punctuation, typos, misuse of capitalisation and mis-spelling. I would recommend that the Kindle edition is thoroughly overhauled in this regard, as well as any future print edition if applicable.

But in summary the author exacts his revenge with words as sharp and clinical as his instruments and I wish him every future success in both his chosen career and his writing.

Second review was a letter from a reader –

“I was most impressed by your book “The Kangaroo Court”. It was an incredibly well written and restrained account of a terrible and unfair ordeal. It brought to mind the novels of Franz Kafka about the terrors of heartless bureaucracies.” – Dr S Galvin, Consultant Psychologist.

To be compared to works of Franz Kafka is an ultimate complement indeed.

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The first edition of The Equator Line lives up to its name. The articles appear to strike a good balance between serious topics such as the current economic problems and the nostalgic journey back in time. The images are striking and appropriately distributed to keep the reader interested and at the same time not losing focus.

I was particularly impressed with the “India:Waiting for a New helmsman” by Bhaskar Roy. He has analysed the bureaucratic woes that beset the country extremely well. The economic assessment of 16th century India and political climate at the time is pretty accurate. The article highlights the dichotomy of economic liberalisation versus continued bureaucratic bottle neck – a legacy of British Raj! It also highlights the absence of any debate on the table about this at present. His correlation of the “head man” of 16th century and the success of the economy should hit the present politicians, if they ever read this article. The analysis of current candidates for the leader of the country shows the grasp of the political mood and characters in the fray extremely well.

I never knew of the numerous success stories of us, Indians abroad until I read “The trophies and triumphs from faraway lands”!! It would be an excellent idea to dedicate one issue on this and get the barons of business in faraway lands write about their experiences. There is a lesson for everyone in this article. It reminded me of a cartoon years ago when the Neil Armstrong landed on the Moon to be greeted by a Chaaiwala!!

The short story by Neeru Iyer tells the rather poignant, slightly improbable story of an young girl. Even though the story of “She is not afraid of spiders” starts off as how her parent meet each other, it turns out to be more of how she finds her mother and eventually her father. It is extremely well written and characterisation of the girl and her interaction with the would be adopted father has been handled brilliantly. There is no soppy sentimentality, and completely matter of fact without losing the emotional value. The mother’s role, though a major character in the story, has been underplayed

– a master stroke I think. Hats off to Neeru Iyer on a brilliant portrayal.

Sondeep Shankar takes you through the life on and in the river Ganges. The images are filled with vibrant colours and lively. Eventhough the images speak for themselves, I wish he had added a caption for the images. I was

curious to know which part of the mighty river was being captured.
The last two articles are essentially about the hill station of Mussorie. Robert Hutchinson gives a nostalgic look at the hill station and the changing face of an old lady because of modernity. It almost makes you feel sad to see an aged relative ageing faster than you want. It is essentially a tongue in cheek travelogue. Ganesh Saili brings out the inimitable Ruskin Bond in his article “A writer for a neighbour”.

Rohit Trilokekar’s “Second Honeymoon” looks at the old fashioned “seven year itch” in a slightly different view point. It is an often trod road with a modern twist. The twist is because of the onslaught of newer inventions – the ever present mobile phone! The article reads more like a well written instruction leaflet to all the newly married!

The Equator Line has started off well and I m sure it will grow into an institution before long.